title: Radiofrequency ablation for early oesophageal squamous neoplasia: outcomes form United Kingdom registry.
abstract: OBJECTIVE
  To report outcomes on patients undergoing radiofrequency ablation (RFA) for early oesophageal squamous neoplasia from a National Registry.
  
  
  METHODS
  A Prospective cohort study from 8 tertiary referral centres in the United Kingdom. Patients with squamous high grade dysplasia (HGD) and early squamous cell carcinoma (ESCC) confined to the mucosa were treated. Visible lesions were removed by endoscopic mucosal resection (EMR) before RFA. Following initial RFA treatment, patients were followed up 3 monthly. Residual flat dysplasia was treated with RFA until complete reversal dysplasia (CR-D) was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond. The main outcome measures were CR-D at 12 mo from start of treatment, long term durability, progression to cancer and adverse events.
  
  
  RESULTS
  Twenty patients with squamous HGD/ESCC completed treatment protocol. Five patients (25%) had EMR before starting RFA treatment. CR-D was 50% at 12 mo with a median of 1 RFA treatment, mean 1.5 (range 1-3). Two further patients achieved CR-D with repeat RFA after this time. Eighty per cent with CR-D remain dysplasia free at latest biopsy, with median follow up 24 mo (IQR 17-54). Six of 20 patients (30%) progressed to invasive cancer at 1 year. Four patients (20%) required endoscopic dilatations for symptomatic structuring after treatment. Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient. The other 2 patients required only a single dilatation to achieve an adequate symptomatic response. One patient developed cancer during follow up after end of treatment protocol.
  
  
  CONCLUSIONS
  The role of RFA in these patients remains unclear. In our series 50% patients responded at 12 mo. These figures are lower than limited published data.
authors.affiliation: Rehan J Haidry, Mohammed A Butt, Laurence B Lovat, Department of Surgery and Interventional Science, National Medical Laser Centre, UCL, London W1W 7EJ, United Kingdom.
authors.forename: Rehan J
authors.initials: RJ
authors.lastname: Haidry
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Butt
authors.forename: Jason
authors.initials: J
authors.lastname: Dunn
authors.forename: Matthew
authors.initials: M
authors.lastname: Banks
authors.forename: Abhinav
authors.initials: A
authors.lastname: Gupta
authors.forename: Howard
authors.initials: H
authors.lastname: Smart
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.forename: Lesley Ann
authors.initials: LA
authors.lastname: Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Willert
authors.forename: Grant
authors.initials: G
authors.lastname: Fullarton
authors.forename: Morris
authors.initials: M
authors.lastname: John
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Pietro
authors.forename: Ian
authors.initials: I
authors.lastname: Penman
authors.forename: Marco
authors.initials: M
authors.lastname: Novelli
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Lovat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D004106:Dilatation; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D012042:Registries; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Endoscopic mucosal resection; High-grade dysplasia; Oesophageal cancer; Radiofrequency ablation; Squamous neoplasia